I am by no means entirely informed on the ACA, but I was just curious about something. With taxes going up, malpractice insurance rates going up, medical school tuition going up, student debt going up, another 33 million patients entering the patient pool, and declining reimbursements for physicians, how does the government plan on answering the physician shortage in the country? Doesn't the combination of all these factors make medicine financially impractical for premeds choosing their careers down the road and also compound the severity of the physician shortage? And with medical schools opening up and/or increasing enrollment, there may be an increase of medical students, but the residency positions have stayed about the same, so how is this supposed to help the country at all? If any informed premeds, or current medical students/MD's can give me some of their insight, that would be great, thanks!
Question about Healthcare
- Thread starter dsk89
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1) They don't. In fact, there's talk of cutting GME funding.
2) Lol if you actually believe that the government can actually do anything productive regarding healthcare, or actually cares about physicians. In fact, the physician shortage is likely to get larger with doctors retiring early (I know a few around my local area who are), and with Gen Y wanting to work less hours to maintain a work-life balance. The most likely solution will be for them to introduce more midlevels, and try paying doctors less per patient to increase productivity.
Face it: Healthcare is beyond repair in this country.
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It's not beyond repair. However, having the government fix it is a joke.
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midlevel providers
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It's not so much the numbers as also the geography. Realistically, very few doctors want to go to a rural area to practice. Take Boston for example. They have more doctors than probably states combined. That's why pay is inversely correlated with standard of living - something rather unique to medicine. A lot of the gap is going to be filled by mid-level providers.
They're trying to get more people to do primary care. UChicago cut their med school class when I applied few years back to give others more financial aid, UCLA now has 1/3 of their class coming in with full merit based scholarships, other schools are trying to promote squeeze med school into 3 years (I think it's actually doable if you have a field in mind already). Whole point is to reduce financial opportunity cost to drive more people into primary care.
So in short - it's a quantity problem but more so a geography + specialty issue.
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This^
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We don't collectively earn enough to get hit with any significant tax increase, no matter what the final deal looks like. Malpractice rates are not going up. In fact they have stagnated and even declined over the last 10-15 years. 33 million people are not entering the patient pool, they are entering the insurance pool. Most of them already utilize the healthcare system. Reimbursements are declining for some fields and increasing for others (mainly primary care).
Tuition and student debt I will grant you.
Contrary to what some might have you believe, we are not f-ed, we are in the middle of an untenable system adjusting to become more stable. I happen to believe it is a great time to pursue primary care. If I had to do it over again I might go FM and establish a small empire of PAs and NPs next to a ski town.
http://www.healthcare.gov/law/information-for-you/clinicians.html
The new website about the ACA has a lot of information, although heavily biased in favor of the government and not describing any of the flaws of the program.
Midlevel healthcare providers will become the standard for many patients; the government is heavily funding new nursing and physician assistant schools, and has even established a fully nurse-run clinical training site (trial before creating more)
Does anybody know how much money a nurse practitioner or PA makes in a primary care practice?
Regarding residency shortages, there will be some small funding (something like 30mill total) to open new residency positions in rural hospitals, mainly in primary care fields and general surgery. These will be guaranteed for primary care positions or the slots will be closed (so they won't be increasing specialists)
There IS some government incentives for schools to open new medical schools, so you can expect to see maybe 3 new med schools a year (hopefully). They usually increase class sizes for the first four years until capacity is reached.
The government is 'hoping' to increase debt forgiveness or deferment for doctors choosing to practice in underserved areas; like others mentioned, the concentration of doctors in cities is very high but most rural areas have severe shortages of physicians. Mainly because doctors have worked their asses off and want to live comfortably while paying off tremendous loans. The new program will potentially allow doctors to save enough money to get ready to pay loans off.
I'm unclear about how they will address how student loans bubble during residency when you only make 40k a year... Does anybody have info on this??
Unfortunately, tuition is still a major issue. Supposedly some schools are going to get funding to support primary care specialties... UCLA's 1/3 of students under full scholarship is actually because of a private donation (by the guy who the med school is named after). It's a pretty remarkable feat, but isolated and I wouldn't expect to see such generosity across the board.
33-34 million people added to the insurance pool is going to be a heavy burden on doctors. 80% of insurance premiums now have to be spent on medical care, so I would expect an even greater increase in 'overtesting' that is a hallmark of American care
The new website about the ACA has a lot of information, although heavily biased in favor of the government and not describing any of the flaws of the program.
Midlevel healthcare providers will become the standard for many patients; the government is heavily funding new nursing and physician assistant schools, and has even established a fully nurse-run clinical training site (trial before creating more)
Does anybody know how much money a nurse practitioner or PA makes in a primary care practice?
Regarding residency shortages, there will be some small funding (something like 30mill total) to open new residency positions in rural hospitals, mainly in primary care fields and general surgery. These will be guaranteed for primary care positions or the slots will be closed (so they won't be increasing specialists)
There IS some government incentives for schools to open new medical schools, so you can expect to see maybe 3 new med schools a year (hopefully). They usually increase class sizes for the first four years until capacity is reached.
The government is 'hoping' to increase debt forgiveness or deferment for doctors choosing to practice in underserved areas; like others mentioned, the concentration of doctors in cities is very high but most rural areas have severe shortages of physicians. Mainly because doctors have worked their asses off and want to live comfortably while paying off tremendous loans. The new program will potentially allow doctors to save enough money to get ready to pay loans off.
I'm unclear about how they will address how student loans bubble during residency when you only make 40k a year... Does anybody have info on this??
Unfortunately, tuition is still a major issue. Supposedly some schools are going to get funding to support primary care specialties... UCLA's 1/3 of students under full scholarship is actually because of a private donation (by the guy who the med school is named after). It's a pretty remarkable feat, but isolated and I wouldn't expect to see such generosity across the board.
33-34 million people added to the insurance pool is going to be a heavy burden on doctors. 80% of insurance premiums now have to be spent on medical care, so I would expect an even greater increase in 'overtesting' that is a hallmark of American care
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/Thread over.
But seriously, increasing the number of nurses and the number of nurse specialties (ie, nurse anesthetists) is probably what we'll fall to when the current system gets worse. Meanwhile, the gov't will sit around in washington, lamenting the fact that healthcare sucks and doing nothing to fix it.
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As somebody else mentioned, physician extenders is the response. Realize that the response is not at the hands of the government, but rather the provider.
I run a PC and specialty practice and have been beefing up on physician extenders. Programs like DSRIP, PCMH make it easier for providers to obtain additional capital through grants to secure extenders. Even then it has created an interesting dynamic as in my area, my local Walgreens has acquired nursing to give flu shots taking away that market share from us.
The answer is going to come from innovation at the bottom. Those that come up with unique solutions such as group visits, telemedicine, etc will be well positioned in the new healthcare environment.
I run a PC and specialty practice and have been beefing up on physician extenders. Programs like DSRIP, PCMH make it easier for providers to obtain additional capital through grants to secure extenders. Even then it has created an interesting dynamic as in my area, my local Walgreens has acquired nursing to give flu shots taking away that market share from us.
The answer is going to come from innovation at the bottom. Those that come up with unique solutions such as group visits, telemedicine, etc will be well positioned in the new healthcare environment.
